<div class="widget_wrap">
    <div class="widget_top">
        <span class="h_icon blocks_images"></span>
        <h6>Edicion de precios item # <?php echo $this->request->data['Medicamentosprecio']['id'] ?></h6>
    </div>
    <div class="widget_content">
        <?php echo $this->Form->create('Medicamento', array('action' => 'ajaxcargaeditar', 'id' => 'formregistrosintoma', 'class' => 'form_container left_label')); ?>
        <?php echo $this->Form->hidden('Medicamentosprecio.id', array('value' => $this->request->data['Medicamentosprecio']['id'])) ?>
        <?php echo $this->Form->hidden('Medicamentosprecio.medicamento_id', array('value' => $id)) ?>
        <ul>
            <li>
                <div class="form_grid_12">
                    <label class="field_title" for="name">Precios<span class="req">*</span></label>
                    <div class="form_input">
                        <?php echo $this->Form->textarea('Medicamentosprecio.precio', array('class' => 'text required', 'tabindex' => '1')) ?>
                    </div>
                </div>
            </li>
            <li>
                <div class="form_grid_12">
                    <label class="field_title" for="username">Seguro</label>
                    <div class="form_input">
                        <select data-placeholder="Seleccione un seguro..." class="chzn-select full" name="data[Medicamentosprecio][seguro_id]" tabindex="4" id="cb_dpto">
                            <option value=""></option>
                            <?php foreach ($seguros as $s): ?>
                                <?php if ($this->request->data['Medicamentosprecio']['seguro_id'] == $s['Seguro']['id']): ?>
                                    <option value="<?php echo $s['Seguro']['id'] ?>" selected="selected">
                                        <?php echo $s['Seguro']['nombre'] ?>
                                    </option>
                                <?php else: ?>

                                    <option value="<?php echo $s['Seguro']['id'] ?>">
                                        <?php echo $s['Seguro']['nombre'] ?>
                                    </option>
                                <?php endif; ?>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
            </li>
        

            <li>
                <div class="form_grid_12">
                    <div class="form_input">
                        <button type="submit" class="btn_small btn_blue"><span>Guardar cambios</span></button>
                        </div>
                </div>
            </li>
        </ul>
        </form>
    </div>
</div>
